today is world prematurity day!

What is world prematurity day?

– a global movement to raise awareness of prematurity.

Across the world an estimated 15 million babies are born too early every year, and 1 million of them die.  Some survivors live with disabilities.

As usual, low and middle income countries are the worst affected, with higher rates of prematurity and lower rates of survival.

The strategies that NICHE International teaches in the Neonatal Care Course, for example early breast feeding and skin to skin mothercare, have been shown to save as many as three quarters of premature babies.

We must continue to try to improve the care of premature babies in low resource settings, despite the current difficulties of the pandemic.

Zooming to Cameroon

Local Cameroonian instructors, who are now organising their own Newborn Care Courses, ran an NCC last week in Yaoundé, Cameroon.  Some NICHE Instructors joined them for parts of the course via zoom from UK, to try out the technology and assess the feasibility of remote training.

We were able, remotely, to:

1. Demonstrate how to run a simulation (this was management of a baby having fits).  NICHE Instructors from their homes in London and N. Ireland did this on zoom at the request of Cameroonian Instructors who watched.

2. Deliver one of the lectures on the NCC course via zoom

3. Join the faculty meetings in Cameroon at the end of each day.

4. Join the candidates for certificate presentation at the end of the course.

This was a useful exercise as we are thinking about the practicalities of training online, in particular delivering ‘Instructor Development Days’ for Cameroonian NCC Instructors, which before the pandemic, we had hoped to be able to do in person in November.

There are some technological improvements to make, but generally it was successful.

It was a pleasure to see our Cameroonian colleagues, who keep going despite pandemic and political difficulties.

Some comments from candidates on the course:

  • The training was an impacting one with lots of skills and knowledge acquired.  I could have wish that all health personnel around the world be train if possible to augment care of neonates.
  • I am confident now that I can take care of a newborn very well as compare to what i was doing in my station, especially resuscitating asphyxiated babies immediately after delivery.

Universal health coverage (UHC)

“Universal Health Coverage (UHC) means that all people can access quality essential health services, without having to suffer financial hardship to pay for health care.”  Says the World Bank which teamed up with WHO in 2017 to monitor progress with this target. https://www.worldbank.org/en/topic/health/publication/universal-health-coverage-study-series

“Each year, close to 100 million people are being pushed into extreme poverty because of health expenses, and 800 million spend more than ten percent of their household budgets on health care. Achieving UHC is not just about better health outcomes. The overarching goal of the Sustainable Development Goals (SDGs)–ending extreme poverty–will remain out of reach without UHC.” [World Bank]

Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable Development Goals in 2015 but, despite this, at least half the world’s population has to pay for some or all essential health services.  People in the poorest countries are the worst affected.

Colleagues in Cameroon, who have been trained by NICHE International to teach a Neonatal Care Course, recently taught this course in Yaoundé.  An important part of the course is the teaching of skin to skin mother care, also called kangaroo care.  This has many advantages and is advocated by WHO as a way of promoting the healthy survival of babies.

Premature baby being kept warm sustainably

Candidates on the course recognised these advantages -see comment below from one candidate.

  • I must comment I learnt a lot on demonstration of S2SMC (skin to skin mothercare) which i thought i could do it but just realised I was far below standard.  This training is so empowering.  Keep up.

However, a problem that became clear during the course, is that one of the hospitals in Yaoundé asks parents for payment whenever a baby is nursed in an incubator.  The hospital management is therefore unwilling for their nurses to introduce skin to skin mother care, as when a baby is nursed with his/her mother, the hospital does not get this payment.  This is despite the fact that skin to skin care is usually better and safer than incubator care, particularly in poorer countries.

There is still much to do to advocate for safe basic healthcare for newborn babies.

Read more on UHC at:

https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Feedback from mboppi course

“This course was very resourceful, I have gained more skills and will transmit the knowledge gained to my colleagues so that together we can improve the neonatal care outcome in Cameroon

Grace and Dr Ngu Ernest, paediatrician in Douala, have just completed a Neonatal Care Course in Mboppi Hospital, one of the Cameroon Baptist Convention Heath Services institutions. 21 candidates attended and all passed the course. The programme used was the ALSG/MCAI one that NICHE instructors have used in the past. It was nice to see that Grace had also included an update for everyone on presentations from the 2nd African Neonatal Nurses Conference in Kenya that she attended with NICHE’s help in November 2019. We are proud to be associated with such an energetic campaigner for newborn care.

Presentations were wonderful and work stations so interesting

Care of the newborn in Cameroon will improve greatly if health care workers are knowledgeable and only such training can help.  I wish such trainings could be open to other health facilities for awareness

I am more and well equip now than before on how to care for baby’s who will not live long

More time should be allocated for workshops

Care of newborn in CBCHS [Cameroon Baptist Convention Health Services] is very high than in other services, so I plead if this course can be extended out to other facilities, we will actually reduce the death rate of neonate in Cameroon

The practical were very educative and interesting

See the blog post below for some images from the recent course delivered by 6 Cameroonian instructors with no input from UK-based NICHE instructors. New definition of sustainability – the excitement experienced when one puts oneself out of a job.

A socially distanced neonatal care course in douala, cameroon

Covid has not deterred our Cameroonian colleagues from running their independent Neonatal Care Courses. Here they are, working hard at the Mboppi Baptist Hospital in Douala this month.

Covid has highlighted the importance of training local instructors. While we have to sit on our hands in the UK, unable to travel to teach, the instructors we have already trained in west Africa are busy cascading best neonatal practice and continuing our joint mission of reducing neonatal mortality.

1m+ social distancing in the classroom keeps the learners as safe as possible.

Credit to Grace and her team for keeping the programme going during this challenging period. An inspiration to us all.

Peer to peer review and mentoring

Medical and nursing staff in the UK now have to undergo annual appraisals, usually with a peer who coaches them through their appraisal paperwork, discussing issues and highlights of the year with them and helping them to develop themselves as a health professional.  Although there’s always a mad rush at the end of the year to get all the relevant bits of paper uploaded to one’s appraisal file in time for the allotted meeting, the process if done well encourages the health worker to focus on their goals for the next year, helps to prevent burn out and allows us all the space to reflect on our own practice.

Agnes, instructor in Liberia

This process is in its infancy in Liberia and Cameroon.  Jarlath has put together a draft form which gathers information about skills and confidence decay, provides a method of assessing someone’s on-going competence and allows a structure for peer mentoring.  We are not quite sure how this will work in the field but will be rolling it out over the next few years in Cameroon while we work out how to help support local instructors in the long term.

Click here for a preview.

 

Breastfeeding workshop

The Neonatal Care Course (NCC) is an educationally robust product.  We teach about the four main areas that the World Health Organisation identifies as contributing maximally to neonatal mortality rates: resuscitation at birth, early breast-feeding, keeping babies warm and early recognition and management of sepsis.  https://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/).  Our feedback forms show increased confidence of learners in all 4 of these areas. Increased clinical confidence correlates with increased performance over time.

Here is Grace, a one time NCC learner and now in-country NICHE champion and convener of their own independent NCCs, delivering a workshop on breastfeeding to local midwives.  This is what empowerment of local health professionals does.  This is our legacy and we are proud of it and very grateful to all who donate time, money and expertise to our charity.

Cameroon Instructor Development Days

We have been busy putting together suitable programmes for our on-going development and support of the local instructors in both Cameroon and Liberia.  We have been asked by Grace and her team in Cameroon to return there once a year for the next 3 years to take them from Step 8 of the “10-steps to sustainability” plan to Step 10 (where they can train their own instructors).  We are actively fundraising for this project at the moment if anyone wants to help out – https://www.nicheinternational.org.uk/ways-to-donate/.

We have begun to put together a tentative programme for a 2-day instructor development course, termed CIDD, which will be delivered in-country to ensure instructors are up to date in both the content and delivery of their provider course, the Neonatal Care Course (NCC), and to furnish them with the skills needed to keep themselves developing professionally after 2023.

Click here for a preview.

Independent Neonatal Care Course

Midwives in Bamenda this week (North West region of Cameroon) learning how to tie a “Kalafong” wrap for skin-to-skin mother care as part of their 2 day Neonatal Care Course.  22 learners with 100% pass rate in a town which is at the centre of the current sociopolitical unrest in Cameroon and to which UK instructors are no longer allowed to travel.  Hats off to Grace and her team for running their first independent course and thanks to our partners, the Cameroon Baptist Convention Health Services, for their support and encouragement.

Alison spreading the word in a Scottish primary school

The children at the primary school where one of the trustees, Alison Grove, works are learning about charities, so she was asked to talk to the classes about NICHE International.

The children are aged between 4 and 12 – one composite class is spread across this whole age range – so there were different levels of understanding about the work we do.

We used coloured blocks to represent babies. With the help of volunteers – wearing our NICHE tee shirts – we counted out how many babies might be cared for if NICHE volunteers spent their visit working in hospitals.

And then how many if they trained local health care workers in the skills they were using so that the work could go on all year round. And finally, how many more babies might survive in good health if the local doctors and nurses learned how to train their co-workers … and so on. That made a lot of blocks.

 

We looked at ways to look after newborn babies:

 Helping them to breathe with a bag valve mask. There were lots of ideas of how to use the one I showed the children, but we soon realised that we would all need training – even the teachers – if we were to save the life of a newborn baby who wasn’t breathing.
 Keeping them warm. The children learned that babies must be kept warm even in hot countries. There were lots of suggestions about how to do this, but no-one could guess the amazing piece of equipment I held behind my back….. a knitted hat!
 Skin to skin contact. We borrowed baby dolls and pieces of fabric from the nursery and the children helped each other to tie the ‘babies’ on securely.

We talked about the different ways people are supporting NICHE – the course tutors, the donors and fund raisers, the work behind the scenes in the UK as well as in the countries we visit.

And there were lots of questions, such as:
How do you set up a charity?
How long does it take to get to Africa?
Why are the babies sick?
Do lions go to hospital?

The children were shocked to learn that newborn babies die so often in poorly resourced areas of the world. Many have baby brothers and sisters of their own and began to understand now how lucky they are to live in Scotland where there are enough well trained health care workers to look after sick babies.